research findings on gender and self disclosure indicate that

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Relationship between self-disclosure to first acquaintances and subjective well-being in people with schizophrenia spectrum disorders living in the community

Kazuki yokoyama.

1 Department of Occupational Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Hokkaido, Japan

Takafumi Morimoto

Satoe ichihara-takeda.

2 Department of Clinical Psychology, Faculty of Health Sciences, Kyorin University, Mitaka, Tokyo, Japan

Junichi Yoshino

3 Department of Nursing, Faculty of Health Sciences, Japan Health Care College, Sapporo, Hokkaido, Japan

Kiyoji Matsuyama

Nozomu ikeda, associated data.

Data cannot be shared publicly due to ethical restrictions imposed by The Sapporo Medical University Ethical Review Board. The data cannot be made public because they contain the demographics and clinical characteristics of each participant. However, the data after statistical processing and the Self-Disclosure scale for people with Mental Illness can be available. For data access requests, interested researchers should contact The Sapporo Medical University Ethical Review Board via email at pj.ca.dempas@irnir .

Focusing on people with schizophrenia spectrum disorders living in the community, the present study aims to examine the characteristics of and gender differences in self-disclosure to first acquaintances, and to clarify the relationship between self-disclosure and subjective well-being.

Participants (32 men and 30 women with schizophrenia spectrum disorders) were examined using the subjective well-being inventory, an original self-disclosure scale for people with mental illness, as well as the Rosenberg self-esteem scale, the Link devaluation-discrimination scale, and the affiliation scale.

The self-disclosure content domains in descending order were as follows: “living conditions,” “own strengths,” “experiences of distress,” and “mental illness and psychiatric disability.” There were no significant gender differences in self-disclosure in the total and domain scores. Multiple regression analyses by gender revealed that: (1) in men, decreasing feelings of ill-being were significantly predicted by self-disclosure about “living conditions,” self-esteem, and perceived stigma; (2) in women, increasing feelings of well-being were significantly predicted by self-disclosure about “own strengths,” self-esteem, and sensitivity to rejection.

Conclusions

Self-disclosure to first acquaintances was related to subjective well-being in people with schizophrenia spectrum disorders living in the community. This result supports the recovery model and the strengths model. It suggests the importance of interventions targeting self-disclosure to first acquaintances about experiences as human beings, such as “living conditions” and “own strengths,” as it relates to subjective well-being in community-based mental health rehabilitation.

Introduction

Community mental health care has evolved around the world. In Japan, since the Ministry of Health, Labour and Welfare [ 1 ] announced its policy to shift away from hospitalized medical treatment, the number of people with mental illness living in the community has gradually increased [ 2 ]. However, there remains a harmful mental health-related stigma in Japan. In particular, schizophrenia is more stigmatized than depression, and the severity of the illness increases the stigmatizing attitude toward it [ 3 ]. Consequently, people with mental illness are often reluctant to express themselves and avoid social participation [ 4 ]. In the present study, we focus on the self-disclosure of people with mental illness, which is important for their recovery.

Self-disclosure is generally defined as an “act of revealing personal information to others” [ 5 ] and is an indicator of stable personality attributes, good psychological adjustment, and mental health [ 5 – 7 ]. Since self-disclosure has a positive relationship with self-esteem [ 5 ] and affiliative motives, including affiliative tendency and sensitivity to rejection [ 8 ], it can be seen as the basis for enhancing well-being. Previous studies exhibited gender differences, in that men are more willing than women to disclose to strangers and acquaintances, but women are more willing than men to disclose to intimates [ 9 ]. Previous studies of self-disclosure in the mental health domain have focused on disability disclosure and coming out with a mental illness. Whether to disclose one’s mental disability at work is an important issue [ 10 ]. Deciding to disclose one’s personal experiences with mental illness is not an easy decision. Many people cope with perceived stigma by withholding their illness and disability. They are able to shelter their shame by not letting other people know about their mental illness [ 11 ]. However, benefits of disclosing disability have also been reported. To recognize disability disclosure as a benefit can diminish the deleterious effects of perceived stigma on quality of life, thereby encouraging people to move toward achieving their life goal [ 12 ].

In previous studies, we chose to focus on the different contents of disclosure (e.g., interests, leisure, daily experiences, strength) by people with mental illness and developed a self-disclosure scale for people with mental illness (hereafter “SDMI”) [ 13 ]. This scale was developed based on the social penetration model [ 14 ], in which the degree of self-disclosure increases with progress in the level of endorsement from others. Our previous study showed that all content domains of the amounts of self-disclosure to close people are positively correlated with subjective well-being [ 13 ]. Considering these findings, our study suggests that disclosing one’s “living conditions” and “own strengths” to close people, in addition to disclosing disability, is important for the well-being of people with mental illness.

While the relevance of self-disclosure to close people became clear in our previous study [ 13 ], the relevance of self-disclosure to first acquaintances has not yet been clarified. “First acquaintances” refers to people meeting each other for the first time in social situations and with whom one will continue to have a relationship in the future. People with mental illness who live in the community have opportunities to interact with first acquaintances; however, some such people have trouble disclosing personal experiences, especially in more casual relationships. The social penetration model [ 14 ] suggests that the amount and depth of self-disclosure are more likely to increase, along with communication of intimate information, when an interpersonal interaction develops toward an intimate relationship. This model leads to the hypothesis that self-disclosure to first acquaintances is lower than that to close people, which may relate to subjective well-being. Additionally, self-disclosure to first acquaintances is difficult for people with mental illness because of public stigma and self-stigma. Under the influence of perceived stigma, it is possible that self-disclosure to first acquaintances differs, in characteristics and its relationships to subjective well-being, from self-disclosure to close people, depending on the content of the disclosure. In clinical practice, it is important to understand self-disclosure to first acquaintances and to support the individual timing and methods of self-disclosure through psychiatric rehabilitation. In particular, this study contributes by clarifying what contents of self-disclosure are associated with subjective well-being.

Focusing on people with schizophrenia spectrum disorders (SSD) living in the community, this study examines the characteristics of self-disclosure to first acquaintances and the related gender differences and clarifies the relationship between self-disclosure and subjective well-being. The present study aims to generate hypotheses about the relationships between self-disclosure to first acquaintances (along with other variables) and the subjective well-being of people with SSD living in the community. A basic assumption of this study is that some domains of self-disclosure to first acquaintances are correlated with subjective well-being (as are other factors previously found to be correlated with subjective well-being), such as self-esteem, perceived stigma, and affiliation motives.

Material and methods

Participants.

The participants were selected from three psychiatric day-care centers and four employment support offices in Hokkaido, Japan. All participants were diagnosed with SSD by trained psychiatrists (F20-29; ICD-10) [ 15 ]. The inclusion criteria were: (i) aged over 20 years; (ii) living in the community without the use of any advocacy services; and (iii) no history of a head injury, mental retardation, or serious medical disease, such as loss of consciousness. We excluded participants who had difficulties understanding ethical considerations and/or the questionnaire items. To calculate the sample size using G*Power ( http://www.gpower.hhu.de ), we utilized ten predictors with 0.80 power at the 0.05 alpha level and an estimated effect size based on our previous study [ 13 ] in reference to Cohen’s proposition [ 16 ]. This process revealed that a sample size of at least 30 was required.

The participants completed the self-administered questionnaire. It consisted of demographic variables, the self-disclosure scale, and questions on subjective well-being, in addition to self-esteem, perceived stigma, and affiliative motives, which are all reported to be related to subjective well-being. Before conducting the survey, researchers explained the contents of the questionnaires using simple words and concrete examples to promote correct understanding. During administration of the questionnaire survey, researchers supported the participants so that they could ask questions and fully understand the questionnaire. This survey was conducted from May to November 2014.

Measurements

Demographic and clinical data.

The demographic variables were as follows: age, gender, education level, and residence status. The clinical variables comprised mental illness duration and the utilization of psychiatric services. After obtaining the participants’ consent, we asked the staff of each research facility to confirm whether the participants’ questionnaire responses were reliable, such as their age and diagnosis. The staff confirmed that no mistakes were made.

Amounts of self-disclosure

Amounts of self-disclosure were measured using the SDMI [ 13 ]. Written in Japanese, this scale asks respondents how much they talk about matters included in 23 items across 4 content domains: “living conditions,” “own strengths,” “mental illness and psychiatric disability,” and “experiences of distress” (see S1 Appendix ). The SDMI items were created based on qualitative analysis of semi-structured interviews in which 18 participants answered questions concerning “what kind of aspects of self are disclosed in daily living?” [ 17 ]. These items were subjected to exploratory factor analysis, resulting in the identification of 23 items distributed among four domains of disclosure content: living conditions, own strengths, mental illness and psychiatric disability, and experiences of distress [ 13 ]. A self-disclosure scale using a similar self-measured questionnaire was used in previous research [ 18 , 19 ]. The validity of self-measured data was shown by comparing it to objective data about self-disclosure obtained through observation [ 18 ]. This scale demonstrated sufficient internal consistency with a Cronbach’s alpha of 0.93, while the four content domains reported Cronbach’s alphas ranging between 0.79 and 0.86 and showed sufficient test-retest reliability and criterion validity [ 13 ]. Participants rated each item using a 5-point Likert scale (1–5), with higher scores indicating greater amounts of self-disclosure. In this study, we set the target for self-disclosure as first acquaintances with whom the participants would continue to have a relationship in the future. Researchers explained this definition to participants and presented specific examples.

Self-esteem

Self-esteem was measured using the Japanese version of the Rosenberg self-esteem scale [ 20 ]. This scale contains ten items and measures positive attitude toward self. Participants rated each item using a 5-point Likert scale (1–5), with higher scores indicating greater self-esteem. This scale previously demonstrated internal consistency, with the first factor contributing 43% [ 20 ].

Perceived stigma

Perceived stigma was measured using the Japanese version of the Link devaluation-discrimination scale [ 21 ]. This scale contains 12 items and measures perceptions of community residents’ beliefs towards people with mental illness. Each item is framed as “Most people think &” in order to minimize social desirability bias. Participants rated each item using a 4-point Likert scale (1–4), with higher scores indicating stronger perceived stigma. This scale previously demonstrated internal consistency with a Cronbach’s alpha of 0.85 [ 21 ].

Affiliation motives

Affiliation motives were measured using the questionnaires on affiliation motives [ 22 ]. This scale contains 18 items across two sub-scales of “affiliative tendency” and “sensitivity to rejection.” The former indicates the inclination to form and maintain intimate relationships with people. The latter indicates the extent of fear of rejection by others. Participants rated each item using a 5-point Likert scale (1–5), with higher scores indicating greater affiliation motives. The subscales “affiliative tendency” and “sensitivity to rejection” previously demonstrated internal consistency with respective Cronbach’s alphas of 0.86 and 0.88 [ 22 ].

Subjective well-being

Subjective well-being was measured using a Japanese version of the Subjective Well-Being Inventory (SUBI) [ 23 ]. SUBI is designed to measure the feeling of well-being or ill-being as experienced by an individual or a group of individuals in various day-to-day life concerns [ 24 ]. This scale contains 40 items across two subscales: “feelings of well-being” and “feelings of ill-being.” Participants rated each item using a 3-point Likert scale (1–3). The total score for feelings of well-being ranged from 19 to 57, with higher scores indicating greater well-being. The total score for feelings of ill-being ranged from 21 to 63, with higher scores indicating lower ill-being. This scale previously demonstrated high internal consistency with Cronbach’s alphas of 0.86 in men and 0.84 in women [ 25 ].

Statistical analysis

Descriptive statistics, including demographic and clinical data, amounts of self-disclosure, self-esteem, perceived stigma, affiliation motives, and subjective well-being were calculated. Internal consistency was measured using Cronbach’s alpha coefficient. Next, variable distribution normality was verified using the Shapiro-Wilk test. The variables departed from the theoretical normal distribution with a slight significance (P<0.05), and so, non-parametric tests were selected. The Mann-Whitney U test was performed to investigate gender differences in each variable. Subsequently, Spearman’s rank correlation coefficients were calculated to investigate correlations between self-disclosure and the other four variables (self-esteem, perceived stigma, affiliation motives, and subjective well-being). After that, stepwise multiple regression analysis was used to examine whether the self-disclosure domains influenced subjective well-being. The variables exhibiting a significant correlation with subjective well-being were regarded as the independent variables, and subjective well-being (feelings of well-being or feelings of ill-being) was regarded as a dependent variable. All statistical analyses were performed using IBM SPSS Statistics 21.0 (IBM Corporation, Chicago, IL, 2012), and the significance level was set at 0.05. We controlled for multiple comparisons using a false discovery rate (FDR) correction at a threshold of 0.05, following Benjamini-Hochberg [ 26 ].

Ethical considerations

This study was approved by the Sapporo Medical University Ethical Review Board (approval number 25-2-42). The research partnership facilities and each participant provided written and verbal informed consent for all procedures. Their anonymity has been consistently preserved. Overall, this study was conducted according to the Declaration of Helsinki.

Table 1 shows the demographic and clinical characteristics of the participants. The participants were 62 people with SSD (32 men and 30 women, aged 20–65 years old). Their mean age was 44.8 (SD = 10.5); the mean duration of illness was 13.0 years (SD = 2.3); and the mean level of education was 13.0 years (SD = 2.3). Sixty-two were diagnosed with SSD (60 with schizophrenia, 2 with schizoaffective disorder). There was no significant gender difference for age, duration of illness, education, diagnosis, or resident status. All participants were ethnically Japanese.

a P-values were derived from an independent t-test for continuous variables and a chi-square test for categorical variables.

Descriptive statistics, internal consistency, and gender differences

Table 2 shows the characteristics of self-disclosure to first acquaintances and the related gender differences. The sum of each domain was divided by the number of its items, and the results were as follows, in descending order: “living conditions” (2.82), “own strengths” (2.54), “mental illness and psychiatric disability” (2.44), and “experiences of distress” (2.44). The five items with the highest self-disclosure amounts were, again in descending order, “work experience,” “leisure time,” “daily occurrences,” “family relationships,” and “habits,” all included in the domain of “living conditions.” Conversely, the five items with the lowest self-disclosure amounts were, in ascending order, “psychiatric experience,” “own role in society,” “methods of coping with mental illness and psychiatric disability,” “medications for the treatment of mental illness,” and “traumatic experiences.” The all-items score and domain scores in SDMI showed no statistically significant gender differences. Moreover, no individual item had a score showing a statistically significant gender difference after FDR correction. The Cronbach’s alpha coefficient of SDMI (total score and all domains) was within the acceptable range, between 0.894 and 0.969.

Note. SDMI: Self-Disclosure scale for people with Mental Illness, SD: standard deviation, IR: interquartile range,α: Cronbach’s alpha coefficient

a Five items with the highest self-disclosure amounts

b Five items with the lowest self-disclosure amounts

Table 3 shows the descriptive statistics and internal consistency for the Rosenberg self-esteem scale, Link devaluation-discrimination scale, questionnaires on affiliation motives, and SUBI. In examining gender difference for each scale, feelings of well-being were demonstrated at a significantly lower scale for men than women. The other variables showed no statistically significant gender differences. The Cronbach’s alpha coefficient of each scale was within the acceptable range, between 0.810 and 0.905.

Note: SUBI: Subjective well-being inventory, SD: standard deviation, IR: interquartile range,α: Cronbach’s alpha coefficient

* Significant after false discovery rate correction

Relationship between self-disclosure and the four variables

Table 4 shows the correlation coefficients between self-disclosure, well-being, and four variables: self-esteem, perceived stigma, affiliation motives, and subjective well-being. For all participants, the total score of self-disclosure was significantly correlated with feelings of well-being (ρ = 0.360, p < 0.01) after FDR correction. Analysis of self-disclosure domains showed that self-disclosure about “living conditions” was significantly correlated with feelings of well-being (ρ = 0.428, p < 0.01) and that self-disclosure about “own strengths” was significantly correlated with self-esteem (ρ = 0.394, p < 0.01) and feelings of well-being (ρ = 0.462, p < 0.001) after FDR correction. However, self-disclosure about “mental illness and psychiatric disability” and “experiences of distress” were not significantly correlated with any of the variables after FDR correction.

Note: SDMI: Self-disclosure scale for people with mental illness; SUBI: Subjective well-being inventory

Next, the correlation coefficients were analyzed by gender. The data for men indicated a correlation between the total score of self-disclosure and feelings of ill-being (ρ = 0.495, p < 0.01) after FDR correction. The self-disclosure domains associated with feelings of ill-being were self-disclosure of “living conditions” (ρ = 0.498, p < 0.01), “own strengths” (ρ = 0.546, p < 0.01), and “experiences of distress” (ρ = 0.484, p < 0.01) after FDR correction. However, self-disclosure about “mental illness and psychiatric disability” had no correlation with feelings of ill-being after FDR correction. By contrast, the data for women indicated no correlation between the total score of self-disclosure and each variable after FDR correction. However, the self-disclosure domains associated with feelings of well-being were self-disclosure about “living conditions” (ρ = 0.553, p < 0.01) and “own strengths” (ρ = 0.630, p < 0.001), but self-disclosure about “mental illness and psychiatric disability” and “experiences of distress” had no correlation with feelings of well-being after FDR correction.

Self-disclosure domains relate to subjective well-being in a stepwise multiple regression analysis

Table 5 shows the domains of self-disclosure, self-esteem, perceived stigma, and affiliation motives, which were significantly associated with the SUBI subscales in stepwise multiple regression analysis. Since the correlations between the independent variables were not strong (|ρ| < 0.90), stepwise multiple regression analyses were performed.

*Significant after false discovery rate correction

For men, the factor retained in the model for feelings of well-being was self-esteem (β = 0.450, p < 0.01). The fitness of the model was low (Adjusted R 2 = 0.378, p < 0.001). The factors retained in the model for feelings of ill-being were self-disclosure about “living conditions” (β = 0.308, p < 0.05), self-esteem (β = 0.392, p < 0.05) and perceived stigma (β = -0.306, p < 0.05). The fitness of the model was good (Adjusted R 2 = 0.523, p < 0.001).

For women, the factors retained in the model for feelings of well-being were self-disclosure about “own strengths” (β = 0.420, p < 0.01), self-esteem (β = 0.548, p < 0.01), and the sensitivity to rejection of affiliation motives (β = 0.400, p < 0.01). The fitness of the model was good (Adjusted R 2 = 0.701, p < 0.001). The factor retained in the model for feelings of well-being was self-esteem (β = 0.424, p < 0.05). The fitness of the model was low (Adjusted R 2 = 0.151, p < 0.05).

This study aimed to examine the characteristic features of and gender differences in self-disclosure to first acquaintances and to clarify the relationship between self-disclosure and subjective well-being. The present results indicate that, with first acquaintances, self-disclosure concerning living conditions is the highest domains indicating “partial disclosure,” whereas that related to experience of illness and distress is the lowest indicating domains indicating almost “little disclosure”. No gender differences were found for the self-disclosure domains. From the multiple regression analyses according to identified characteristics for each gender, men’s feelings of ill-being were related to self-disclosure about “living conditions,” self-esteem, and perceived stigma; by contrast, women’s feelings of well-being were related to self-disclosure about “own strengths,” self-esteem, and sensitivity to rejection.

This is the first study to investigate self-disclosure to first acquaintances. The first key point of this study is the amount of self-disclosure. Based on the results, we formulated the following hypothesis: in each of the four domains, people with SSD living in the community tend to self-disclose to first acquaintances less frequently than that to close people, in accordance with our previous findings [ 11 ]. This hypothesis supports a social penetration model [ 14 ], which claims that the breadth and depth of self-disclosure are more likely to increase with the building of personal relationships.

The second key point of this study is the relationships between self-disclosure domains and subjective well-being. Self-disclosure to first acquaintances regarding “living conditions” and “own strengths” are positively correlated with subjective well-being, but self-disclosure regarding “mental illness and disability” and “experiences of distress” are not. This differs from our previous finding that subjective well-being is related to all domains of self-disclosure to close people [ 13 ]. This study suggests only that the act of disclosing these matters to first acquaintances was more likely to be reported by those with higher ratings of well-being. It is critical that people with SSD are accepted when disclosing their experiences as human beings, such as their “living conditions” and “own strengths,” when encountering anyone in community life. The psychological recovery model [ 27 ] states that hope and self-determination lead to a meaningful life and a positive sense of self, regardless of the presence of mental illness. The strengths model [ 28 ] focuses on people’s strengths rather than their deficits. It demonstrates the importance of their passions, skills, interests, relationships, and environments. The present results are expected to support the recovery and strengths models. However, they do not necessarily suggest that people with SSD should disclose the self on first meeting a new acquaintance. It is important to disclose aspects of oneself at an appropriate time in the formation of interpersonal relationships.

This study also investigated gender differences as they relate to self-disclosure. For the self-disclosure total score and domain scores, no significant gender differences were found. These results were not in line with those reported by a previous study of undergraduates [ 9 ]. It can be presumed that participants would tend to disclose neither about their illness/disability nor about details of their life experiences resulting from mental illness/disability regardless of gender. Internationally, mental health stigma is a central issue for people with mental illness [ 3 , 11 , 12 ], and it is a likely influence on low subjective well-being and the avoidance of interpersonal relations. There is a weak negative association between perceived stigma and self-disclosure to close persons [ 13 ]. In addition, deficits in metacognitive processes [ 29 , 30 ], such as navigating interpersonal relationships and first-person experiences in the moment, and overlooking own positive aspects and motives, might lead to lesser degrees of self-disclosure. However, contrary to expectations, the present study indicated that self-disclosure to first acquaintances was not related to perceived stigma, but rather, to self-esteem and affiliation tendency. Therefore, in the early stages of interpersonal relationships, self-disclosure, rather than the level of perceived stigma, could be a major contributor to a feeling of worthiness to “be human” and a desire to form relationships regardless of illness or disability.

Multiple regression analyses by gender revealed the relationship between self-disclosure and subjective well-being. Among men, self-disclosure about “living conditions” showed a significant correlation with feelings of ill-being, as did self-esteem and perceived stigma. The present results thus suggest that self-disclosing examples of daily events, habits, and leisure time pursuits could be related to relieving perceived ill health and negative affect. Men more strongly predicted negative ramifications of disclosure than did women, such as feeling vulnerable, feeling uncomfortable, having a weakness exposed, and being rejected by the person to whom they reveal information [ 31 ]. However, men reported being more willing than women to disclose to strangers and acquaintances [ 9 ]. Men may be motivated to form interpersonal relationships through self-disclosure as a result of the elimination of negative ramifications.

For women, self-disclosure about “own strengths” showed a significant correlation with feelings of well-being, as did self-esteem and affiliation tendency. The present results thus suggest that self-disclosure of examples of motivation, self-growth, and personal goals could be related to subjective well-being, for example, through expectation-achievement congruence and transcendence. Women more strongly predicted positive ramifications than did men, such as the clarification of information about the self and increases in intimacy, trust levels, satisfaction, and feelings of acceptance by a target person [ 31 ]. Relatedly, women with schizophrenia spectrum disorders have previously reported higher positive mental health, such as “emotional support” and “personal growth and autonomy,” compared to men [ 32 ]. In this respect, it is possible that women have a more positive attitude to self-disclosure than men. Positive attitude helps to enhance the relationship between self-disclosure about one’s own growth and subjective well-being. As above, these correlations are in the same direction for both genders, though the qualities of well-being related to self-disclosure differed by gender. It may be effective for the therapist to understand gender differences in each aspect of self-disclosure.

The present study has several limitations. First, the small sample size and exclusive focus on Japanese culture may limit the generalizability of results. Second, this study cannot determine causality due to its cross-sectional design. The multiple regression analysis should, therefore, be treated as a pilot study on which future research can build through a longitudinal design, using mediation analysis or path analysis, including self-disclosure and subjective well-being, to advance the interpretation of results. Third, the self-disclosure scale was measured by participants recalling meetings with first acquaintances. Therefore, it might not accurately measure actual self-disclosure. In addition, multicenter studies will be necessary to investigate both subjective and objective self-disclosure. Fourth, the influence of self-disclosure on age trends was not taken into consideration. A previous study clarifies the age trends in self-disclosure amount with regard to the target person [ 33 ]. In the present study, participants were aged from 20 to 65 years, but it is necessary to investigate the influence of age on self-disclosure.

In conclusion, our findings suggest that self-disclosure to first acquaintances is related to subjective well-being in people with SSD. The self-disclosure domains most strongly related to subjective well-being differed by gender: “living conditions” for men and “own strengths” for women. On the other hand, this study suggests that a lack of disclosure is related to negative effects on quality of life. This study’s impact is its focus on the importance of self-disclosure in the context of psychiatric rehabilitation, encouraging therapists to support people with SSD to practice self-disclosure to first acquaintances as a method of recovery, which can be implemented using psychosocial intervention. Therapists can establish a therapeutic group, such as through group therapy or social skills training, in which individuals can disclose their living conditions and their own strengths to first acquaintances in community-based rehabilitation. At the same time, it is necessary to respect their self-disclosure and provide support that emphasizes individuality. We believe that self-disclosure is important in SSD recovery from the client’s point of view, and clients should not be compelled into disclosure at the initiative of the therapist. Timing and styles for promoting self-disclosure should vary between individuals.

Supporting information

S1 appendix, acknowledgments.

The authors wish to especially thank all the participants and staff who facilitated data collection. This paper was supported by Sapporo Medical University. The authors declare no conflict of interest.

Funding Statement

This paper was supported by Sapporo Medical University. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data Availability

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Strengths and limitations, clinical implications, conclusions, disclosure of self-injurious thoughts and behaviors across sexual and gender identities.

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Taylor A. Burke , Alexandra H. Bettis , Sierra C. Barnicle , Shirley B. Wang , Kathryn R. Fox; Disclosure of Self-Injurious Thoughts and Behaviors Across Sexual and Gender Identities. Pediatrics October 2021; 148 (4): e2021050255. 10.1542/peds.2021-050255

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Evidence suggests that sexual minority (SM) and gender minority (GM) youth are more likely to experience self-injurious thoughts and behaviors (SITBs) than heterosexual and cisgender youth. A major barrier to identifying and treating SITBs is nondisclosure. In this study, we explored differences in SITB disclosure patterns between SM and GM youth and their heterosexual and cisgender peers. In this study, we further examined the association between discrimination experiences and SITB disclosure.

Adolescents ( N = 931) completed questionnaires assessing demographics, SITBs, disclosure history, disclosure barriers, future intentions to disclose SITBs, and discrimination history.

Few differences in SITB disclosure patterns emerged between SM and GM youth and heterosexual and cisgender youth ( P > .05). SM and GM youth endorsed greater rates of fear of disclosure to and worrying parents, two parent-related barriers ( ⁠ χ 2 2 = 8.11, P = .017; χ 2 2 = 7.25, P = .027). GM youth reported greater discrimination experiences than SM youth (F = 6.17, P = .002); discrimination experiences impacted their willingness to disclose future SITBs more so than their SM and heterosexual and cisgender peers (F = 11.58, P < .001). Among the full sample, more discrimination experiences were associated with lower previous disclosure honesty to therapists and pediatricians ( r = −0.09 to −0.10, P < .05). Among SM and GM youth, discrimination experiences were associated with lesser odds of disclosing suicide attempts in the future ( r = −0.12, P < .05).

Minority stress experiences may interfere with SITB disclosure, particularly among GM youth. Targeted interventions should be considered to reduce minority stress and support disclosure.

Evidence suggests that sexual minority and gender minority (GM) youth experience higher rates of self-injurious thoughts and behaviors (SITBs) than their heterosexual and cisgender counterparts. However, research has yet to explore whether these differences are observed in SITB disclosure.

Results suggest few differences in SITB disclosure patterns between sexual minority and GM youth seeking treatment and their heterosexual and cisgender counterparts. However, our findings suggest that minority stress experiences may interfere with SITB disclosure, particularly among GM youth.

Lesbian, gay, bisexual, transgender, gender nonconforming, queer, and questioning (LGBTQ+) youth are at significantly elevated risk for self-injurious thoughts and behaviors (SITBs). Evidence suggests that LGBTQ+ youth are at least 2 to 3 times more likely to experience suicidal thoughts and 3 to 5 times more likely to attempt suicide than their cisgender heterosexual counterparts. 1 – 3   LGBTQ+ youth are also at heightened risk for nonsuicidal self-injury (NSSI) (self-injury that is engaged in without suicidal intent), with upward of 29% of sexual minority (SM) (including those with some or exclusive same-gender romantic or sexual attraction or those who experience no romantic or sexual attraction) youth and 46% of gender minority (GM) (including those who identify with any gender distinct from their birth-assigned sex) youth reporting a history of this behavior. 4   The elevated rates of SITBs among LGBTQ+ youth are highly concerning because meta-analytic evidence suggests that both suicidal thoughts and NSSI are prospectively predictive of suicide attempts 5   and that suicidal thoughts and suicide attempts are prospectively, although weakly, predictive of death by suicide. 6  

A major barrier to being identified as at risk for SITB outcomes and receiving appropriate treatment is nondisclosure. A growing body of literature suggests that a majority (60%–66.2%) of those who have a history of suicidal thoughts do not disclose these thoughts to others. 7   Omitting information about one’s history of SITBs when interacting with health care providers, or dishonesty when responding to direct questions inquiring about suicide risk, impedes identification and treatment. Unfortunately, there are numerous barriers to SITB disclosure, including concerns about stigma, involuntary hospitalization, and medication prescription, as well as shame, embarrassment, and beliefs that one is unable to be helped. 8 – 10  

The minority stress model 11 , 12   suggests that experiences of minority stress, including discrimination, violence, and victimization, underlie disproportionately poorer mental health outcomes (eg, depressive and anxiety symptoms, substance use) among LGBTQ+ individuals. Building on this model, sexual and gender minority (SGM) stress may result in increased psychosocial (eg, shame, peer and/or familial rejection) and mental health risk factors for the development of SITBs and thus may be central to the elevated SITB rates observed among LGBTQ+ individuals. 13 , 14   Recent evidence indicates that minority stress may also be associated with lower rates of SITB disclosure among LGBTQ+ youth. 15  

However, no studies to our knowledge have directly compared SITB disclosure rates and barriers to disclosure between LGBTQ+ and non-LGBTQ+ youth. In addition, no studies have examined differences in SITB disclosure rates between SM and GM youth, despite evidence that minority stress is not uniform across SM and GM individuals. 12   A direct comparison is necessary to elucidate potential patterns of and barriers to disclosure that are specific to or more pronounced among SM and GM youth. Similarly, although minority stress is associated with SITB nondisclosure among LGBTQ+ youth, 15   it is unclear whether disclosure varies between SM, GM, and cisgender heterosexual youth or whether minority stressors account for potential differences in disclosure between these groups. Relatedly, no studies have compared rates of SITB assessment across groups, which is essential to examine to contextualize potential differences in disclosure rates. Such information is critical to tailor interventions to these high-risk populations so as to encourage disclosure, augment assessment accuracy, and increase treatment use.

We first aim to evaluate whether there are differences in the rate of therapists’ and pediatricians’ assessments of SITBs between cisgender heterosexual, SM, and GM youth. The second aim of this study is to examine whether rates of SITB disclosure patterns to friends and parents or guardians differ between cisgender heterosexual, SM, and GM youth. The third aim is to assess group differences in disclosure honesty to therapists and health care providers and in endorsed barriers to such disclosure. The fourth aim is to examine associations among minority stress (ie, discrimination experiences due to a minoritized identity) and SITB disclosure and to further examine these associations specifically among LGBTQ+ youth. Given the dearth of empirical evidence examining group differences, we consider study aims 1, 2, and 3 to be exploratory and thus do not put forth hypotheses. However, we hypothesize that we will replicate previous literature finding that greater minority stress is associated with lower suicide-related disclosure intentions among LGBTQ+ youth. 15  

We recruited participants through paid Instagram ads, which directed individuals to a Qualtrics-based eligibility screening survey. Eligibility was determined on the basis of age (13–17 years old), English language comprehension, living in the United States, having a SITB history, and having a history of mental health treatment. Qualified individuals who provided assent received a link to the full study on Qualtrics; parental consent was waived for this study. All individuals who completed the screener and/or full study were provided with mental health resources; all participants who completed the full study were entered into a lottery for $25 gift cards. Full details about recruitment, screening, and procedures are provided by Fox et al (K. Fox, A. H. Bettis, T. A. Burke, E. A. Hart, S. B. Wang. Exploring adolescent experiences with and impacts of disclosing self-injurious thoughts and behaviors across settings, unpublished observations). All procedures were approved by the Harvard University Institutional Review Board.

Participants were included in the analytic sample if they responded to questions about sexual orientation and gender identity. Because demographics were assessed at the end of the study, this yielded a total of 931 (mean age = 15.7, SD = 1.11) of the original 1706 participants who started the study. Participants reported substantial diversity across sexual orientation and gender, with moderate racial and ethnic diversity (see Table 1 ). At the intersection of sexual orientation and gender identity, 117 (12.6%) participants identified as cisgender heterosexual, 338 (36.3%) as GM, and 476 (51.1%) as SM. Participants’ average socioeconomic status was 5.82 (SD = 1.68, range = 1–10), as assessed with the MacArthur Scale of Subjective Social Status – Youth Version. 16   Higher scores indicate higher social standing.

Sample Demographics

Screening Survey

We assessed eligibility using items from the Self-Injurious Thoughts and Behavior Interview-Revised, 17   including items assessing lifetime history of NSSI, suicidal ideation, and suicide attempts. We used single items to assess lifetime history of mental health treatment.

Demographics

We assessed age, race, ethnicity, sexual orientation, and socioeconomic status. We assessed gender using a measure with a wide range of gender identities. 18   Participants were able to select multiple genders and sexual orientations.

History of SITB Disclosure

Several items were used to assess SITB disclosure. SITB history was first determined with the question “Have you ever told anyone about times where you [purposely hurt yourself without wanting to die/had thoughts of killing yourself/tried to kill yourself]?” Second, participants were asked to think of times they had engaged in a given SITB in their life. Third, participants were instructed to report who they had told about each SITB engagement using a Likert scale ranging from 0 (never) to 4 (every time); options included parent or guardian, therapist, psychiatrist or doctor (who prescribes mental health medication), doctor you see for check-ups and physicals (ie, pediatrician), another adult you trust, sibling, friend, acquaintance, someone you met online, and other. To maximize statistical power for paired analyses, we focused analysis on disclosure to friends and parents or guardians.

Future Likelihood of SITB Disclosure

We asked participants to report their likelihood of disclosing each SITB with a therapist in the future on a scale from 0 (not at all) to 4 (extremely).

Provider SITB Assessment and Honesty

We asked participants if providers (including pediatricians and/or medical providers and mental health professionals and/or therapists) had ever asked them about each SITB, separately, with response options of “yes,” “no,” and “don’t remember”; current analyses only considered yes and no responses. We also asked participants how honest they were in disclosing each SITB to pediatricians and/or medical providers and mental health professionals and/or therapists using a scale ranging from 0 (not at all honest) to 4 (completely honest).

Barriers to Disclosure

We adapted items from Hom et al 8   to assess barriers to disclosure to mental health professionals and/or therapists. We added items relevant to adolescents (eg, telling parents or guardians) and aimed to reflect additional forms of stigma (eg, shame).

Expanded Everyday Discrimination Scale

The Expanded Everyday Discrimination Scale measures the extent to which participants experience chronic, everyday forms of discrimination (eg, “You receive poorer service than other people at restaurants or stores”). Participants were asked to rate each experience from 1 (never) to 5 (almost every day). The original scale has been validated and has strong psychometric properties in an adolescent sample. 19  

First, we examined whether therapists’ and pediatricians’ and/or medical providers’ assessments of specific SITBs differed across identities, including participants identifying as SM or GM (ie, SGM) and cisgender heterosexual (ie, non-SGM). Results were mixed. Pearson χ 2 tests revealed a significant main effect of SGM status on therapist assessment of NSSI ( ⁠ χ 2 2 = 9.84, P = .007) but no main effect of therapists’ assessments of suicide ideation or attempts. For the purpose of SGM subgroup analyses, the GM group included individuals identifying as GM, some of whom also identified as SM; the SM group only included those identifying as SM (but not GM). Holm-corrected post hoc tests revealed that therapists were more likely to directly ask participants who identified as GM compared with SM about their NSSI histories, with no other differences across groups emerging. Pearson χ 2 tests revealed no main effect of pediatricians’ and/or medical providers’ assessments of any SITB across identities ( P > .40).

Second, we tested for differences in the frequency of SITB disclosure to friends and parents or guardians across groups. Across SM, GM, and non-SGM participants, identical disclosure patterns emerged across SITBs (see Fig 1 ). Third, we examined whether SGM identity impacted self-reported honesty in disclosure to both therapists and pediatricians and/or medical providers. Analysis of variance tests revealed that SGM identity did not significantly impact disclosure honesty across any SITB to either provider (see Fig 2 ).

Association of sexual and gender identities with frequency of disclosure to parents or guardians and friends. CI, confidence interval; obs, observations.

Association of sexual and gender identities with honesty of disclosure to providers. CI, confidence interval; obs, observations.

Fourth, we explored whether barriers to SITB disclosure to therapists differed across SGM and non-SGM youth. See Table 2 for the top 5 barriers endorsed among participants identifying as SGM and non-SGM. χ 2 tests revealed that only 2 of these barriers received significantly different endorsements across SGM identity groups. Specifically, main effects were observed for the belief that the therapist would tell a parent or guardian ( ⁠ χ 2 2 = 8.11, P = .017) and for fear of worrying the parent or guardian ( ⁠ χ 2 2 = 7.25, P = .027). Holm-corrected post hoc tests revealed that non-SGM participants were significantly less likely to endorse the belief that a therapist would share with a parent or guardian compared with GM participants ( P = .0346), and relatedly, non-SGM participants were significantly less concerned that this information would worry a parent or guardian compared with both SM ( P = .024) and GM participants ( P = .037).

Top 5 Endorsed Barriers to Disclosing SITBs to a Therapist

Fifth, we examined whether the frequency of discrimination experiences differed across groups and whether there were group differences in the frequency of discrimination impacting willingness and/or desire to disclose SITBs to therapists across SGM identities. As shown in Fig 3 , results of Welch’s one-way analysis of variance were significant. Holm-corrected post hoc tests revealed that GM participants reported significantly greater discrimination experiences than those identifying as SM (no other significant differences emerged). Regarding the impact of such experiences on future disclosure willingness, Holm-corrected post hoc tests revealed significantly greater impact for GM-identifying participants compared with both SM and non-SGM participants. See Supplemental Table 3 for the reasons for discrimination reported within the study sample.

Discrimination and its impact across sexual and gender identities (pairwise comparisons: Games-Howell test; adjustment [ P value]: Holm). Discrimination was assessed with the Expanded Everyday Discrimination Scale. CI, confidence interval; obs, observations.

Sixth, we conducted Pearson correlations to examine the impact of discrimination experiences on previous and future willingness to disclose SITBs both in the full sample and in only SGM participants. Among the full sample, small negative correlations were observed between discrimination experiences and past SITB disclosure; significant associations were not observed with future willingness to disclose ( Fig 4 ). Our findings partially supported our hypotheses; when considering only participants identifying as SGM, these associations became largely insignificant, with one exception: odds of disclosing suicide attempts in the future.

Relationships between discrimination and disclosure honesty to pediatricians and therapists. Discrimination was assessed with the Expanded Everyday Discrimination Scale. X, nonsignificant at P < .05 (adjustment: none).

The present study investigated the differences in SITB disclosure patterns between cisgender heterosexual, SM, and GM youth. Results suggested few differences in disclosure of SITBs to friends and parents or guardians and in disclosure honesty to therapists, as well as with related primary barriers to disclosure. However, our findings provide some evidence supporting the minority stress model, revealing that minority stress experiences may interfere with SITB disclosure, particularly among GM youth.

Although patterns of disclosure were similar across SM, GM, and non-SGM youth and across provider types, some notable differences emerged. GM participants were more likely to express the concern that a therapist would share with a parent or guardian as a barrier to disclosure. Both SM and GM participants were more likely to report the related barrier to disclosure that this information would worry a parent or guardian compared with non-SGM participants. Given that family support is tied to improved mental health outcomes in SGM youth, 20 , 21   SGM youth who experience SITBs may be particularly worried about maintaining their relationship with their parents. Fear of disrupting their caregiver relationship(s) further may contribute to their SITB disclosure decision. Although no differences in rates of SITB disclosure to parents emerged, additional research examining family-related factors associated with SITB disclosure decision-making is warranted. Results highlight the need to provide psychoeducational resources for parents both to mitigate such barriers and to respond to initial disclosure in a manner that will facilitate ongoing disclosure.

GM youth also reported significantly greater discrimination experiences than those identifying as SM, and these discrimination experiences impacted their willingness to disclose SITBs in the future more so than their SM and non-SGM peers. Results are somewhat consistent with previous work that found minority stress was associated with lower likelihood of SITB disclosure. 15   Prospective research is needed to determine if discrimination experiences predict disclosures over time, particularly in GM youth, and to explore specific mechanisms that may play a role in this relationship. In addition, although both SM and GM youth report elevated rates of SITBs, some research suggests that GM youth may be at particularly high risk because of higher levels of discrimination and lower levels of acceptance across family, peers, and society. 4   Additional research is necessary to elucidate how GM youth’s specific experiences with discrimination may impact SITB disclosure to inform clinical guidelines and intervention efforts for these youth.

Across the full sample, previous discrimination experiences were associated with lower rates of previous SITB disclosure honesty but not future disclosure willingness. Reasons for this discrepancy necessitate future prospective research. For example, it is possible that positive disclosure experiences may influence individuals’ willingness to disclose in the future, despite previous experiences of discrimination. Alternatively, the relationship between minority stress exposure and disclosure honesty may depend on their temporal connection or may differ on the basis of the specific domain of minority stress assessed (eg, family rejection, health care discrimination, peer victimization). Disentangling discrimination factors, both specific to LGBTQ+ youth and experienced across other minoritized identities, that contribute to how youth make decisions to disclose SITBs will be an important area of future investigation.

Finally, although most associations among discrimination experiences, disclosure honesty, and future disclosure willingness were not statistically significant in this sample of SGM youth, one important association emerged. Greater discrimination experiences in SGM youth were associated with lower intention of disclosing suicide attempts, but not suicidal ideation or NSSI, in the future. Results did not replicate those of Chang et al, 15   who found that greater minority stress was associated with lower intention to disclose suicidal thoughts in the future. Lack of replication here may relate to differences in measurement of minority stress; Chang et al 15   employed a specific measure of SGM stress, whereas the measure used in this study was not specific to SGM experiences.

Strengths include the recruitment of a large sample of adolescents with a history of SITBs and the successful employment of targeted recruitment efforts to increase the proportion of LGBTQ+ youth in our sample. We also assessed disclosure and related barriers across a range of SITBs because both rates of disclosures and barriers to disclosures may differ across SITB types.

That said, several issues limit generalizability of results. Most notably, we did not assess whether participants were “out” to close others, including parents, friends, or providers; results may differ as a function of outness and may not generalize to older LGBTQ+ populations. Additionally, this study relied on adolescent self-report. Observational and/or medical record data from health care providers (eg, assessing rates of provider SITB assessment) may be useful in future research. Future researchers should also consider incorporating qualitative methods to identify additional LGBTQ+-specific factors, as well as individual differences, that may influence SITB disclosure. The cross-sectional nature of this study precludes causal inferences; prospective data are needed to better understand disclosure likelihood as well as barriers and their association with SITBs over time. General psychopathology and distress may have impacted retrospective recall related to disclosure. However, we did not measure current levels of psychopathology or distress in the current study and thus cannot rule out their impact on findings. Although recruiting a large proportion of LGBTQ+ youth was a strength of this study, there remain limitations regarding our assessment of multiple minority identities and minority stress experiences. Because of the sample’s racial and ethnic homogeneity, we were unable to explore whether differences also emerged for racial and ethnic minority groups. We were also unable to examine differences within subgroups of LGBTQ+ identities. Research suggests bisexual individuals are at elevated risk for SITBs compared with both those who identify as lesbian or gay and those who identify as heterosexual 22   ; whether similar differences emerge in rates of or barriers to disclosure in this subpopulation is an important area for investigation.

Intervention targeting SITBs in youth relies, in part, on adolescents’ willingness to share their SITB experiences. Results from the current study highlight the importance of considering the parent-child relationship when inquiring about and treating youth SITBs. Parents may benefit from direct guidance around how to support their child in discussing SITB experiences, particularly parents of GM youth. In addition, clinical interventions that address effective ways to cope specifically with discrimination experiences are needed.

Disclosure honesty is a critical component of SITB assessment and intervention in youth. In the current study, we explored whether SM, GM, and cisgender heterosexual youth report differences in SITB disclosures, and few differences emerged. Findings highlight the need for prospective research examining SITB disclosures over time as well as mechanisms that may contribute to disclosure likelihood and honesty in youth.

FUNDING: Drs Burke (T32 MH019927; K23 MH126168) and Bettis (K23MH122737) were supported by the National Institute of Mental Health. Ms Wang was supported by a National Science Foundation Graduate Research Fellowship (DGE-1745303). The National Institutes of Health and National Science Foundation had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of National Institutes of Health or National Science Foundation. Funded by the National Institutes of Health (NIH).

Drs Burke and Bettis conceptualized and designed the study, drafted parts of the initial manuscript, and reviewed and revised the manuscript; Dr Fox conceptualized and designed the study, conducted the data analysis, coordinated and supervised data collection, drafted the Results section of the initial manuscript, and reviewed and revised the manuscript; Ms Barnicle and Ms Wang drafted parts of the initial manuscript and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

gender minority

lesbian, gay, bisexual, transgender, gender nonconforming, queer, and questioning

nonsuicidal self-injury

sexual and gender minority

self-injurious thought and behavior

sexual minority

Competing Interests

Supplementary data.

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Gender differences in online and offline self-disclosure in pre-adolescence and adolescence

Affiliation.

• 1 School of Communication, Amsterdam School of Communication Research ASCoR, University of Amsterdam, The Netherlands. [email protected]
• PMID: 21199497
• DOI: 10.1348/2044-835X.002001

Although there is developmental research on the prevalence of offline self-disclosure in pre-adolescence and adolescence, it is still unknown (a) how boys' and girls'online self-disclosure develops in this period and (b) how online and offline self-disclosure interact with each other. We formulated three hypotheses to explain the possible interaction between online and offline self-disclosure: the displacement, the rich-get-richer, and the rehearsal hypothesis. We surveyed 690 pre-adolescents and adolescents (10-17 years) at three time points with half-year intervals in between. We found significant gender differences in the developmental trajectories of self-disclosure. For girls, both online and offline self-disclosure increased sharply during pre- (10-11 years) and early adolescence (12-13 years), and then stabilized in middle and late adolescence. For boys, the same trajectory was found although the increase in self-disclosure started 2 years later. We found most support for the rehearsal hypothesis: Both boys and girls seemed to use online self-disclosure to rehearse offline self-disclosure skills. This particularly held for boys in early adolescence who typically have difficulty disclosing themselves offline.

Publication types

• Research Support, Non-U.S. Gov't
• Gender Identity*
• Interpersonal Relations*
• Longitudinal Studies
• Models, Psychological
• Netherlands
• Practice, Psychological
• Psychology, Adolescent*
• Self Disclosure*
• Socialization

• Open access
• Published: 20 January 2023

Self-disclosure, mindfulness, and their relationships with happiness and well-being

• Basim Aldahadha   ORCID: orcid.org/0000-0001-6630-4718 1  

Middle East Current Psychiatry volume  30 , Article number:  7 ( 2023 ) Cite this article

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Metrics details

This study aims to test how self-disclosure relates to mindfulness, whether self-disclosure or mindfulness best predicts happiness and well-being, and whether there are significant differences between happiness and well-being levels due to self-disclosure and mindfulness. Data from a public sample was collected using e-mails and social media platforms ( N = 486).

The findings demonstrated a weak relationship between mindfulness and self-disclosure ( r  = 0.16) and acting with awareness but a strong relationship between happiness, wellness, mindfulness, and its factors. The results revealed four values that predict the differentiation between happy and unhappy people, and these values are statistically significant, namely, mindfulness, description, acceptance without judgment, and self-disclosure, as well as four values that predict the distinction between being well and unwell, namely mindfulness, observation, description, and self-disclosure. Additionally, results showed significant differences in the means of each of the mindfulness predictor variables in favor of happiness, wellness, and females. For the self-disclosure variable, the results showed differences in its means favoring females, happiness, and wellness. Finally, when controlling for gender and age, regression analyses found mindfulness to be an important predictor for happiness and well-being at 59% and 48% of the variance, respectively, while self-disclosure was a weak predictor at 12% and 15%, respectively.

Conclusions

In general, the results indicate that mindfulness is more effective and beneficial for living a happy and healthy life than self-disclosure

Positive psychology has received much attention in recent decades to the extent that many researchers believe this is the era of positive psychology [ 1 ]. Among the most critical variables studied in light of this approach are wellness, self-disclosure, mindfulness, and happiness, and many articles revealed a highly positive relationship between these variables [ 2 , 3 ]. In the Hellenistic era, philosophers were the ones interested in the topics of happiness and wellness; however, at present, psychologists are now interested in studying happy people and the factors that contribute to living well. Nowadays, these topics are converging with both philosophers and psychologists attempting to integrate these concepts [ 4 ].

Happiness is an indicator of wellness, life satisfaction, and improved self-image [ 2 , 5 ]. It boosts the immune system, regulates hormone levels, reduces inflammation, and promotes a healthy lifestyle [ 6 ].

Happiness is a positive emotional state with value and significance in all cultures. People differ in their preferences for desirable positive emotions and pleasure states, which Mauss et al. [ 7 ] referred to as valuing happiness. The scientific assumption is that most people strive to achieve higher happiness levels by achieving their goals. Several studies have shown a negative relationship between happiness and low wellness, poor social support, low academic achievement, and mood disorders. Accordingly, happiness is necessary for good life and wellness [ 8 ]. Ford and Mauss [ 9 ] have postulated three mechanisms by which happiness affects wellness: very high standards of happiness, over-reviewing pleasure experiences, and activities to follow up on positive outcomes and their permanence, resulting in negative emotions such as self-blame and apology. Accordingly, people seeking to improve their happiness levels may experience anxiety and depression and suffer from more life stresses [ 8 ].

Moreover, Bachik et al. [ 10 ] have stated that maintaining a high level of character strength leads to more positive and joyful results, including happiness, self-acceptance, life satisfaction, self-efficacy, psychological health, physical health, and the presence of a rich and beneficial support network, respect for self and others, job satisfaction, and healthy communication with family [ 11 ]. Studies have also shown a relationship between psychotherapy and happiness and wellness and a negative relationship between happiness and depression and people’s low experiences of happiness [ 12 ]. Wellness promotes the development of a person’s abilities and talents, allowing them to recognize and appreciate them [ 13 ]. Furthermore, wellness is associated with ideal weight maintenance and long-term weight loss [ 14 ].

Although happiness is a subjective self-feeling of well-being and contentment, it is affected by political and social conditions and is negatively affected by the lack of basic conditions of life [ 15 , 16 ]. Happiness has many definitions, including the personal feeling that everything is fine, it relates to how people evaluate their lives, work, health, and relationships, and it also includes emotions of joy and attachment and the absence of unpleasant emotions such as anger, sadness, and fear [ 17 ]. Furthermore, happiness is defined as a stable situation in which the individual balances their desires and life satisfaction. It is also defined as using emotional and mental behavior to reach pleasant and positive feelings [ 18 ]. There are three main criteria for happiness: to be valued in all cultures, to be valued in themselves, and to be learnable. Moreover, four characteristics distinguish happy people from others: their love for themselves, their typical sense of control over their lives, a strong sense of control over their lives, and a tendency to be optimistic. Finally, most happy people are extroverted [ 19 ].

In 2008, a longitudinal study was published on the contagion of happiness that followed the lives of 4739 people over 20 years and found that the amount of a person’s happiness is significantly related to the happiness of those around them and that someone’s happiness increases the probability of the happiness of those around them by 25%, indicating that happiness spreads from the happy person to other around them [ 20 ]. Based on a review of previous studies, it is clear that Arab research on happiness is few and far between [ 18 , 21 , 22 ]. In any case, most research around the world faces a significant challenge in differentiating between happiness and wellness and that wellness is one of the components of happiness, with a separate definition for each [ 23 ].

The topic of mindfulness has received significant attention around the world, not only recently but also 2500 years ago, as it is one of the teachings of the Buddhist religion. Most religions worldwide use the contents and methods of mindfulness and meditation in some way or another [ 24 , 25 ]. Mindfulness is defined as paying attention to the present and accepting its experiences with openness and no judgments. The main components of mindfulness are attention, intention, and direction, as well as the ability to focus on current stimuli and control them [ 26 ]. Many stimuli in life affect us frequently, and the mind does not respond to some of these stimuli and, in turn, focuses attention on others. Another benefit of mindfulness is that it allows us to distinguish between the various stimuli that we are exposed to [ 27 ]. Mindfulness necessitates paying attention to one’s experiences before deciding the path one intends to take. Therefore, we need patience, self-compassion, and acceptance [ 28 ]. According to studies, mindfulness is linked to many mental health issues because it can reduce psychological stress. When one’s level of mindfulness is high, this contributes to increasing happiness and sexual desire as well as self-disclosure. A high level of mindfulness also contributes to a better awareness of wellness because the individual will be able to deal with stress successfully when dealing with others [ 29 , 30 , 31 , 32 , 33 , 34 ].

Because mindfulness includes the mind (consciousness) and the heart (compassion), the quality of mindfulness training consists of both through meditation [ 35 ]. According to Kabat-Zinn [ 36 ], mindfulness depends on cultivating awareness to assist people in living the moment they love despite the pain that surrounds them. Mindfulness is nowadays one of the most well-known methods of psychotherapy used by most psychologists in all theoretical directions, from analytical to cognitive behavioral, and it serves as the foundation of the rational emotive treatment approach [ 37 ].

Self-disclosure is of great importance in the field of psychotherapy; it fosters trust and attachment between the therapist and the patient [ 38 ]. Self-disclosure does not imply that the individual is entirely transparent but rather that they must keep some secrets that cause embarrassment and insecurity, which might lead back to other psychological problems [ 39 ]. For decades, most definitions agreed that self-disclosure is verbal statements related to mental health and to a person’s experiences that are used to improve the patient’s mental health status [ 40 ]. Self-disclosure is defined as revealing personal information to others so that others are more aware and familiar with it. Online self-disclosure has become more common as social networking sites have grown in popularity [ 41 ].

According to research, 90% of therapists use self-disclosure; however, this technique is still ambiguous in terms of its effectiveness compared to other counseling methods. This ambiguity caused difficulties in comparing the effectiveness of self-disclosure with other counseling methods, as well as a lack of criteria to evaluate its effectiveness over time [ 42 , 43 ]. Self-disclosure about significant events in one’s life can take several forms, including verbal and written disclosure, and over the last three decades, it has been shown to improve mental health and reduce negative emotions and pressures [ 44 ].

The study’s problem

Little data exist in the research literature on the relationship between self-disclosure and both happiness and wellness and the relationship between mindfulness and happiness and wellness. No study differentiates between the predictive ability of both self-disclosure and mindfulness in happiness and wellness. Thus, this study explores the extent to which self-disclosure and mindfulness predict happiness and wellness and the difference between them. The scientific assumption states that the greater the self-disclosure, the greater the happiness and wellness and the greater the mindfulness, the greater the happiness and wellness [ 45 ]. Therefore, the problem of the study lies in answering the following questions:

Is there a statistically significant relationship between both self-disclosure and mindfulness and happiness (happy or unhappy) and wellness (well and unwell)?

Is there a statistically significant relationship between the study variables that predict the degree of happiness according to the level of happiness (happy and unhappy) and the level of wellness (well and unwell)?

Are there any significant differences in the means of the self-disclosure and mindfulness attributed to the level of happiness (happy and unhappy) and the level of wellness (well and unwell)?

Which is the best predictor of happiness and wellness, self-disclosure or mindfulness?

The purpose and importance of the study

Some studies have found that mindfulness can help with emotional and wellness disorders [ 46 ]. As a result, the study’s significance emerged from the ambiguity of the reciprocal relationship between the effects of self-disclosure and mindfulness on happiness and wellness because no study combined happiness and wellness variables to investigate the relationship between self-disclosure and mindfulness and no Arab studies examined these concepts together or in part, according to the researcher’s knowledge. It is essential and valuable to investigate the extent to which self-disclosure is related to mindfulness and whether both self-disclosure and mindfulness predict wellness and happiness. This study aims to explore the differences in the means of self-disclosure and mindfulness according to related variables, which will be reflected on the clinical and therapeutic side and contribute to establishing the relationship between self-disclosure, on the one hand, and mindfulness, on the other hand, and both happiness and wellness.

Participants and procedures

The study sample included 486 people whose ages ranged from 18 to 62 years, with a mean age of 26.9 years and a standard deviation of 11.13. The sample consisted of 364 males (75%) and 122 females. In this sample, 42% were employed in either government departments or the private sector or had their own work or overtime work; the rest were unemployed. Additionally, the unmarried constituted 52% of the total sample of the study. The study’s data were obtained via social networking sites and e-mail, and each person was asked to kindly resend the questionnaires to all the individuals participating with them in the group so that they, in turn, fill out the scales and return them to the original sender, thereby increasing the size of the sample in a snowball manner. Approximately 543 questionnaires were sent, and it is worth noting that the contents of the questionnaire were sent using the Mourners Recruited system, which allows the data to be automatically unloaded.

The approval to participate in the research was obtained by informing the participants that they send the questionnaire only if the data were correct, and they were not obliged to fill it out and had the freedom to do so. The confidentiality of the information has been confirmed. Moreover, the results of this study and the information they send will only be used for scientific research purposes, and the identity of the examinee cannot be revealed. Most of the questionnaires were obtained via various social networking sites, and anyone under the age of 18 years old or not Jordanian was excluded. According to the principles of the Helsinki Declaration, which includes maintaining research ethics, there is no need to obtain official approval from any party or even from the scientific research committees as long as the examinees have the right to refuse to participate and disclose their names or any information indicating them.

Instruments

• Self-disclosure

For assessing self-disclosure, we used the Jourard self-disclosure questionnaire [ 47 , 48 ], which consisted of 60 items distributed at an average of 10 items for each of the following six factors: attitudes and opinions, tastes and tendencies, work and study, financial status, personality, and physical condition. It should be noted that the total score on the six dimensions in the self-disclosure questionnaire is determined by the extent to which the individual speaks about each of the items of each of these factors by choosing one of the following four alternatives: (1) I lie or present myself to the other person in a wrong way (0 degrees); (2) I do not talk about this item (0 degrees); (3) I speak in general and not in detail (1 degree); (4) I speak in perfect detail (2 degrees). Note that all the items are positive; thus, the highest score is 120 on the scale as a whole and 20 on each factor as a maximum. The lowest score is 0. The higher degree indicates a high self-disclosure, while the lower degree indicates a low self-disclosure. Sulaiman and Aldahadha [ 49 ] conducted the procedures of validity and reliability, where appropriate modifications were made to the original version. The values of the reliability by the test-retest reliability were 0.84 for the father and 0.90 for the friend of the same sex.

For this study, the validity and reliability of the tool were confirmed again. Then, the tool was presented to 10 arbitrators specialized in the field of Counseling and Mental Health at Yarmouk University and Mutah University, and the arbitrators approved the original version. The reliability was also evaluated using the test-retest method on a sample of 88 males and females. The reliability for the dimensions of the self-disclosure scale ranged between 0.89 and 0.64, while that of the scale as a whole was 0.87.

• Mindfulness

Kentucky Inventory of Mindfulness Skills (KIMS) [ 50 ] is a 39-item questionnaire. It was translated to the Arabic edition [ 24 ], with four subscales: observation, i.e., “I notice when my moods begin to change”; description, i.e., “my natural tendency is to put my experience into words”; acting with awareness, i.e., “when I’m reading, I focus all my attention on what I’m reading”; acceptance without judgment, i.e., “I make judgments about whether my thoughts are good or bad.” Respondents rate the extent to which they endorse each item on a 5-point Likert-type scale (never, very rarely, true, very often, or always(. The Arabic version was translated into English and presented to 10 arbitrators fluent in both Arabic and English to assess the extent to which the meaning in the English version translated from Arabic matches the original English version. The scale in its English translation from the Arabic version is exactly the same as the original English version.

The scale was tested by evaluating the validity of the criterion to confirm the validity of the scale. The scores of the total Mindfulness Skills Scale were positively correlated with those of the emotional intelligence scale [ 51 ] and negatively correlated with the scale of the neurotic responses [ 52 ] and the Automatic Negative Thoughts Scale [ 51 ], as the degrees of correlation were 87.0, − 82.0, and − 91.0, respectively. To ensure the scale’s reliability, the test-retest reliability, with an interval of 2 weeks between the two applications, indicated that the stability for the overall scale is 0.89. As for the scale factors, the Pearson correlation values were 0.78, 0.80, 0.76, and 0.88. Moreover, 25 items had a positive direction, whereas the rest had a negative correlation, the total score on the entire scale ranges from 39 to 195, and the higher degree indicated higher mindfulness skills.

The Arab Scale of Happiness

This scale includes 20 items, 15 of which measure happiness, as well as five filler phrases, so some respondents do not answer the scale at the same pace. Each item is answered based on the five-point Likert scale, which ranges from no (1) to very much (5). The total score on the scale ranges from 15 to 75, and a higher score indicates high happiness. For this study, a cut-off score of 31 and above was adopted for the high level of well-being. This scale is appropriate for adults and adolescents. The factorial analysis of the items of this scale revealed two factors: general happiness and successful life. The correlations between the item and the total score ranged between 0.42 and 0.77, and Cronbach’s alpha ranged between 0.82 and 0.94, indicating a high internal consistency and stability. Over time, the Arab happiness scale was also positively correlated with the measures of mental health, life satisfaction, optimism, love of life, and self-esteem, which ranged between 0.55 and 0.79. This scale has two versions: Arabic and English [ 53 ]. In this study, Cronbach’s stability was 0.85 and 0.90 in males and females, respectively.

Tennant et al. [ 54 ] have developed a well-being scale, which consists of 14 items within a one-dimensional scale, and its items are answered in a five-step gradation according to the Likert scale, where the number 0 indicates “never,” while the number 4 indicates “daily,” and the respondents’ responses range from 0 to 56 so that the highest degree indicates “a high level of well-being.” For the purposes of this study, a cut-off score of 30 and above was adopted for happy people. Note that all the items on the scale are in the positive direction; for example, “I feel that I have extra energy”; “I deal with problems well”; “I always think clearly”; “I feel satisfied with myself.” The scale achieved good psychometric properties in its initial form and was used in many international societies and languages, including the Jordanian version [ 55 ].

Statistical analysis

Pearson’s correlation analysis was used to explore the relationship between self-disclosure and mindfulness; then, Wald’s test was used to detect scores for predicting wellness and happiness according to the self-disclosure and mindfulness scales and after controlling for age and gender. Multiple-way analysis of variance was used to detect the differences between happy and unhappy and well and unwell according to the self-disclosure and mindfulness variables and their factors. Finally, the hierarchical regression analyses of well-being and happiness were applied.

A correlation analysis was performed between the study variables to answer the first question, “Is there a statistically significant relationship between self-disclosure and mindfulness and both the level of happiness (happy and unhappy) and the level of wellness (well and unwell)?” The results showed a weak correlation between mindfulness and self-disclosure ( r = 0.16) and the factor acting with awareness ( r = 0.14) and between the factor acting with awareness and unhappy people ( r = − 0.15). On the other hand, a statistically significant relationship was observed between happiness and wellness and its levels and mindfulness and its five factors and self-disclosure. As expected, the results showed a negative relationship between the unhappy people factor and all measures and the unwell factor. See Table 1 .

To answer the second question, a linear regression analysis was performed to compare the happy and unhappy people factors. The results showed that four values predict the differentiation between happy and unhappy people. These values are statistically significant: mindfulness at Wald = 11.07 and its significance level at p < 0.01; description at Wald = 4.68 and its significance level at p < 0.05; acceptance without judgment at Wald = 6.53 and its significance level at p < 0.05; self-disclosure at Wald = 8.59. Table 2 also shows that four values predict the differentiation between the well and unwell factors. These values are statistically significant: mindfulness at Wald = 19.03 and its significance level at p < 0.01; observation at Wald = 7.81 and its significance level at p < 0.05; description at Wald = 9.74 and its significance level at p < 0.05; and self-disclosure Wald = 11.02.

To answer the third question, multiple analysis of variance was performed. Table 3 represents the means and standard deviations of the self-disclosure and mindfulness variables in light of independent variables to verify the significance of the differences between the means. The results showed significant differences in the mean of mindfulness attributed to the variable happiness and in favor of the happy factor ( F = 12.132, p < 0.001). The results showed differences in the mean of description attributable to wellness ( F = 6.66, p < 0.010) and acting with awareness factor in favor of females ( F = 4.38, p  < 0.037) and wellness ( F = 6.60, p  < 0.010). As for the dependent variable, self-disclosure, the results showed differences in its mean score in favor of females ( F = 8.49, p < 0.004), happy ( F = 7.51, p < 0.006), and wellness ( F = 5.84, p < 0.016). Note that the effect size of the significant values ranged from a weak value to a medium value. See Table 4 .

A regression analysis was conducted after fixing the happiness and wellness variables as dependent variables to answer the fourth question. Table 5 shows that gender and age were added in the first step, explaining 9% of the probability of happiness. However, gender had a statistically significant effect higher than age ( t = 1.71, p < 0.01). When mindfulness was added in the second step, 59% of the probability of predicting happiness was explained, which is also statistically significant ( t = 3.82, p < 0.001). In the third step, self-disclosure was added to explain 12% of the total interpretation of the independent variables for happiness ( t = 0.89, p < 0.01). Finally, Table 6 shows that gender and age were added in the first step and they explained 8% of the probability of wellness. Moreover, gender had a higher statistically significant effect than age ( t = 1.55, p < 0.01). When mindfulness was added in the second step, 48% of the probability of predicting wellness was explained, which is also statistically significant ( t = 3.93, p < 0.001). In the third step, self-disclosure was added to explain 15% of the total independent variables for well-being ( t = 1.32, p < 0.01).

This study explores the relationship between self-disclosure and mindfulness in light of the variables of happiness and wellness. The results revealed that the relationship between self-disclosure and mindfulness was weak and not statistically significant. In other words, no scientific or therapeutic inference can be obtained between them. Furthermore, the results showed a weak and not statistically significant relationship between acting with awareness and mindfulness and acting with awareness and unhappiness. On the other hand, all the other relationships between self-disclosure and mindfulness in light of the happiness (happy and unhappy) and well-being (well or unwell) variables were statistically significant. This result can be explained by the fact that happiness and wellness can be achieved through the practice of self-disclosure and mindfulness. These findings concurred with the results of Fowler and Christakis’ [ 20 ] research, which indicates that happiness spreads from the happy individual to those around them

The results showed that four values predict the differentiation between happy and unhappy, and these values have statistical significance: mindfulness, description, acceptance without judgment, and self-disclosure. The results also showed that four values predict the distinction between the well and unwell variables, and these values have statistical significance, namely, mindfulness, observation, description, and self-disclosure. Thus, we can say that a positive therapeutic value is attributed to the mindfulness variable and its three domains in predicting happiness and wellness [ 8 ], while the field of acting with awareness had no therapeutic value. Accordingly, these results enhance the effectiveness of positive psychology in obtaining a happy life full of wellness; therefore, they pave the path toward dealing with life’s stresses and overcoming many psychological disorders [ 56 ].

The results showed that both gender and age explained 9% of the probability of wellness and gender had a higher statistically significant effect than age. When mindfulness was added in the second step, it explained 59% of the probability of predicting wellness, which is also significant. In the third step, self-disclosure was added to explain 12% of the total explanation of the independent variables for wellness. Finally, both gender and age explained 8% of the probability of wellness, and gender had a statistically significant effect higher than age. When mindfulness was added in the second step, it explained 48% to explain the probability of predicting wellness, which is also statistically significant. In the third step, self-disclosure was added to explain 15% of the total independent variables for happiness. These results indicate that mindfulness is more powerful in predicting states of happiness and wellness than self-disclosure because mindfulness mainly focuses on the present and ignores the past and the future. On the other hand, self-discovery focuses on recalling the painful past and predicting an unknown future. The results of this study are very much in agreement with the results of previous studies [ 4 , 24 ].

This is the first Arab and international study to explore the extent to which self-disclosure and mindfulness are related to happiness and wellness in a sample of public people. For the first time, this study has used two scales together: mindfulness and self-disclosure, which are codified in the Arab and Jordanian environments. Moreover, this study has essential dimensions in terms of providing psychotherapists with new facts about the importance of focusing on the concepts of self-disclosure and mindfulness in living a happy, healthy life, and wellness, in addition to exploring the difference in the predictive ability of each in happiness and wellness. Alternatively, while the results of this study are directed toward positive psychology, there is a saying that states, “the goodness shows his fineness the opposite,” as it is important to benefit from the findings of this study to treat most psychological disorders. Furthermore, most of the results indicated a correlation between mindfulness and self-disclosure and the rest of the study variables, according to a number of studies [ 29 , 30 , 31 , 32 , 33 , 34 ].

Therefore, we recommend conducting new studies on a sample of patients and other groups of mental disorders. The findings are determined by the extent of the sincerity of the respondents’ answers to the scales, keeping in mind that the sample was general and was done based on the person’s desire to fill out the questionnaire. In general, the results indicate that mindfulness is more effective and beneficial for living a happy and healthy life than self-disclosure.

Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Aldahadha, B. Self-disclosure, mindfulness, and their relationships with happiness and well-being. Middle East Curr Psychiatry 30 , 7 (2023). https://doi.org/10.1186/s43045-023-00278-5

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Sexual Consent: How Relationships, Gender, and Sexual Self-Disclosure Affect Signaling and Interpreting Cues for Sexual Consent in a Hypothetical Heterosexual Sexual Situation

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Sexual communication is critical to establishing sexual encounters. Sexual script theory has been used to explore how individuals communicate sexual consent and perceive sexual consent cues. Gender differences appear to dictate how consent cues are expressed and interpreted. Using a sample of 309 U.S. heterosexual participants (Mage = 34.6 years, range = 19.3–72.2), we explore how single and partnered women and men interpret and perceive cues for consenting to sexual behaviors in a hypothetical situation. Results revealed that relationship length and sexual self-disclosure did not affect how individuals would communicate sexual consent; gender differences were identified as women reported being more likely to interpret their use of direct forms of communication as consent indications whereas men reported they were more likely to interpret their use of indirect communication strategies as consent indications. Within-subjects analyses suggest that some forms of communication would be interpreted differently depending on if they were to be used by the participant or used by the participant’s partner. Although there is considerable agreement across genders on what classes of behaviors are indicative of consent, differences in the sexual scripts of men and women may contribute to gender differences in consent. Given these gender and within-subjects’ differences, further research is needed to explore the nuances of sexual communication.

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Acknowledgements

We would also like to acknowledge Cynthia Meyer and Tai Mendenhall’s critiques and comments during the writing process as well as Heidi Fall’s help editing and formatting.

Thanks to the University of Minnesota Department of Family Medicine and Community Health, especially Heidi Fall for her editing and formatting as well as the critiques and comments from Cynthia Meyer and Tai Mendenhall during the writing process.

This research was funded by a dissertation award from the University of Minnesota Family Social Science Department and by the National Institutes of Health’s National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health’s National Center for Advancing Translational Sciences.

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Newstrom, N.P., Harris, S.M. & Miner, M.H. Sexual Consent: How Relationships, Gender, and Sexual Self-Disclosure Affect Signaling and Interpreting Cues for Sexual Consent in a Hypothetical Heterosexual Sexual Situation. Sex Roles 84 , 454–464 (2021). https://doi.org/10.1007/s11199-020-01178-2

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Published : 23 July 2020

Issue Date : April 2021

DOI : https://doi.org/10.1007/s11199-020-01178-2

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